Research

Review of the Use of Complementary and Alternative Medicine by Non-Hispanic Blacks

John Ward, DC, MA, MS

 

Kelley Humphries, MS

 

Caroline Webb, MS, MLIS

 

Michael Ramcharan, DC, MPH, MUA-C

 

author email    corresponding author email   

Topics in Integrative Health Care 2013, Vol. 4(1)   ID: 4.1003



Published on
March 10, 2013
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Abstract

Introduction: Complementary and Alternative Medicine (CAM) has been on the rise over the past two decades. However, most CAM surveys demonstrate that blacks use CAM less often than whites. There is a shortage of review articles summarizing this discrepancy in use. Therefore a greater understanding of the true prevalence of different forms of CAM used by blacks is warranted.

Methods: This review was generated through a three-step process. The first step involved a 2002-2011 literature search performed using key terms: African Americans, blacks, complementary therapies, prayer, herbal medicine, massage therapy, chiropractic, acupuncture, and mind-body therapies. Databases included the Index to Chiropractic Literature, PubMed, Alt Health Watch, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The intent was to find all peer-reviewed original articles about Non-Hispanic black usage of major forms of CAM during the intended time frame. The second step involved hand-searching numerous journal articles for relevant studies. The third step involved reference tracking of the articles that had already been discovered to find new articles. Following screening, articles were then grouped thematically for discussion purposes as follows: acupuncture, chiropractic, herbal medicine, massage therapy, mind-body therapies, and prayer as forms of CAM, as well as CAM use articles for specific health conditions.

Results: Thirty-six original articles met the inclusion criteria. This was composed of thirty-five original surveys and one focus-group analysis.

Conclusion: The existing evidence suggests that Non-Hispanic blacks use CAM significantly less than whites, with the exception of prayer. The reason for this difference should be further investigated.

Introduction

Complementary and Alternative Medicine (CAM) has steadily been on the rise over the past two decades.1-4  In the Institute of Medicine’s 2005 report on CAM they stated that additional studies are needed to better understand CAM therapies that are used by Americans and which populations use them.5
 
In general, whites are more prone to seek out CAM treatments and therapies in comparison to other ethnic groups. This is especially true when compared to blacks.  For example, one such study found that 43.1% of white adults sought out CAM treatments and therapies in comparison to 25.5% of blacks.2 The most prevalent reasons presented as to why whites used CAM more often than blacks have been: higher education, increased annual income, and a more positive perception of the healthcare system in general.1-4
 
To our knowledge there has only been one review article summarizing blacks’ use of CAM.6 Unfortunately, the article only focused on one form of CAM, religion.  Additionally, there is minimal research that provides an explanation as to why blacks utilize CAM less often.1-4  Thus a more robust review is needed to develop a clearer picture of black use of multiple forms of CAM. 
 
The purpose of this systematic review is to summarize the usage of prayer, herbal medicine, massage therapy, chiropractic, acupuncture, and mind-body therapies by Non-Hispanic blacks.

Methods

This study was deemed exempt by Texas Chiropractic College’s IRB.

Search Strategy



This review article was generated through a three-step process.  We attempted to identify all peer-reviewed original articles about Non-Hispanic black usage of major forms of CAM during the intended time frame in North America.  The first step involved a literature search performed using key terms: African Americans, blacks, complementary therapies, prayer, herbal medicine, massage therapy, chiropractic, acupuncture, and mind-body therapies.  This search covered a ten-year time frame from Jan 2002-Dec 2011 in English only.  Databases involved included the Index to Chiropractic Literature, PubMed, Alt Health Watch, and Cumulative Index to Nursing and Allied Health Literature (CINAHL).
 
Article inclusion criteria were: articles discussing the intended forms of CAM used by blacks, publication during 10-year time frame, English language, survey or focus group studies, populations included were North American only, and proportions of blacks using a given form of CAM must be specified.

Article exclusion criteria were: abstracts only, letters/editorials, review articles, linkset analysis, papers which had methodology descriptions inadequate to interpret their results, and case reports.
 
The following search terms were utilized for the Index to Chiropractic Literature: ("African Americans" OR blacks) AND (“Complementary Therapies” OR prayer OR acupuncture OR massage therapy OR “Herbal Medicine” OR "Mind-Body Therapies") with “peer reviewed citations” selected.

The following search terms were for PubMed: ("African Americans"[MeSH] OR blacks) AND (“Complementary Therapies” [MeSH] OR prayer OR chiropractic OR acupuncture OR massage therapy OR “Herbal Medicine” [MeSH] OR "Mind-Body Therapies"[MeSH])
 
The following search terms were used for Alt Health Watch and CINAHL: ("African Americans" OR blacks) AND (“Complementary Therapies” OR prayer OR chiropractic OR acupuncture OR massage therapy OR “Herbal Medicine” OR "Mind-Body Therapies")
 
The second step involved hand-searching the following journals for relevant articles:
  • The Journal of Alternative and Complementary Medicine
  • Focus on Alternative and Complementary Therapies
  • Alternative and Complementary Therapies
  • Alternative Medicine Review
  • Alternative Therapies in Health and Medicine
  • Journal of Manipulative and Physiological Therapeutics
 
The third step of the literature search involved reference tracking.  This was the process of reviewing the references of all of the articles that were found in the two original steps of our process. 

Review Strategy and Grouping



Following this step, all papers were screened as outlined in Fig. 1.  At the conclusion of screening a total of 36 papers remained.  Due to the limited number of papers, and in some cases overlapping data sets, on the use of CAM by non-Hispanic blacks, no attempt to rate these papers through a systematic mechanism was performed. 

Articles were then grouped by CAM practices as follows: prayer, herbal medicine, massage therapy, chiropractic, acupuncture, and mind-body therapies.  The following study characteristics were extracted from each article: first author, study design, black and white participant count, major findings, and whether whites or blacks used that given form of CAM more often.

Non-Hispanic blacks will be referred to as blacks, and African Americans, who are considered a sub-classification of blacks, will be abbreviated as AA as they were described by each original author.

Figure 1:  Journal screening process.


Results

The majority of the comparisons in this study demonstrated that blacks use CAM less than whites. Table 1 demonstrates that 7 articles found blacks used religion more often than whites. Five demonstrated a greater than 10% difference in favor of blacks using this form of CAM.  Contrasting this occurrence, one article described white dominance in the use of religion as a form of CAM over blacks with a difference greater than 10%. 

Table 1 Non-Hispanic black use of prayer.

 
Authors,
Data source
Black
White
Main results
Lead
publication year,
 
n, sex, age
N, sex, age
 
%1
citation
 
 
 
 
 
Cuellar et al.
Convenience sample
40
143
83.8% of whites used prayer as a form of CAM
B
2003 (7)
survey
both
both
90.0% of AAs used prayer as a form of CAM
 
 
 
(50+ yrs)
(50+ yrs)
 
 
Dessio et al.
Cross-sectional survey
812
none
43% of AA women reported using spirituality for health reasons
NA
2004 (8)
 
females only
 
  in the past year
 
 
 
(18+ yrs)
 
Factors associated with the use of religion/spirituality as a form of CAM
 
 
 
 
 
  in the past year were: income ($40,000-60,000), college education
 
 
 
 
 
  or higher, age (37-56 years-of-age), and worse health status
 
Conboy et al.
1997-1998 National
199
1,636
77.0% of whites used self-prayer as a form of CAM
W*
2005 (9)
Sample
both
both
9.6% of blacks used self-prayer as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Goldstein et al.
2001 California Health
961
3,660
55.5% of whites reported CAM use in general
B*
2005 (10)
Interview Survey
both
both
5.8% of AAs reported CAM use in general
 
 
Complementary and
(18+ yrs)
(18+ yrs)
44.0% of whites used prayer as a form of CAM
 
 
Alternative Medicine
 
 
66.0% of AAs used prayer as a form of CAM
 
 
supplement (CHIS-CAM)
 
 
 
 
Hsiao et al.
2001 California Health
961
3,660
32.4% of whites reported others prayed for their health as a form
B*
2006 (11)
Interview Survey
both
both
  of CAM
 
 
Complementary and
(20+ yrs)
(20+ yrs)
56.3% of AAs reported others prayed for their health as a form of CAM
 
 
Alternative Medicine
 
 
 
 
 
supplement (CHIS-CAM)
 
 
 
 
Kronenberg
Cross-sectional
1,081
757
37.1% of non-Hispanic whites used spirituality/religion/prayer as a
B
et al.
telephone survey
females only
females only
  form of CAM
 
2006 (12)
 
(18+ yrs)
(18+ yrs)
42.8% of AAs used spirituality/religion/prayer as a form of CAM
 
Brown et al.
2002 National Health
4,256
none
67.6% of AAs reported using CAM in the past 12 months
NA
2007 (13)
Interview Survey (NHIS)
both
 
CAM users were more likely female, college-educated, older, and insured
 
 
 
(18+ yrs)
 
60.7% of AAs used prayer in the past 12 months as a form of CAM
 
Xu & Farrell
Medical Expenditure
7,196
27,584
25.4% of non-Hispanic whites used prayer as a form of CAM
B*
2007 (14)
Panel Survey (MEPS)
both
both
48.9% of blacks used prayer as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Wilkinson et al.
2002 National Health
3,620
24,940
43.3% of whites prayed for their health within the past 12 months
B*
2008 (15)
Interview Survey (NHIS)
both
both
62.8% of blacks prayed for their health within the past 12 months
 
 
 
(18+ yrs)
(18+ yrs)
Black women were 11% more likely to have visited a primary care physician
 
 
 
 
 
  that same year if they reported praying regularly
 
 
 
 
 
Participants that prayed were more likely to be female, over the age of 58,
 
 
 
 
 
  and black
 
Brown et al.
2002 National Health
4,256
none
If prayer for health reasons was included in the definition of CAM then
NA
2009 (16)
Interview Survey (NHIS)
both
 
  67.6% of AAs reported CAM use in the past 12 months
 
 
 
(18+ yrs)
 
If prayer for health reasons was not included in the definition of CAM then
 
 
 
 
 
  27.0% of AAs reported CAM use in the past 12 months
 
 
 
 
 
The following variables were predictors of CAM use: middle-aged to older,
 
 
 
 
 
  female gender, and a high school or greater education
 
Barner et al.
2002 National Health
2,952
none
33.3% of AAs used prayer as a form of prevention-based CAM
NA
2010 (17)
Interview Survey (NHIS)
both
 
 
 
 
 
(18+ yrs)
 
 
 
Upchurch et al.
2002 National Health
879
3,933
49.8% of whites used prayer for health reasons as a form of CAM
B*
2010 (18)
Interview Survey (NHIS)
females only
females only
77.4% of blacks used prayer for health reasons as a form of CAM
 
 
 
(40-59 yrs)
(40-59 yrs)
 
 
 
1 Lead % = a given form of CAM is used more by one ethnicity over the other.
*= a greater than 10% difference between whites and blacks for the primary chart dependent variable monitored. 
 
W= Whites use a given form of CAM more than blacks.  B= Blacks use a given form of CAM more than whites.
 
Draw= there is a mixture of dominance by whites and blacks for a table main dependent variable.
 
NA= article only discussed black use of CAM. 
 


 
Regarding herbal medicine use, Table 2 demonstrates that 12 articles found 2hites to user herbal medicine more than blacks and 5 articles found that blacks used it more often. Upon close review of the white lead in herbal medicine use as a form of CAM, 4 articles demonstrated greater than a 10% difference in favor of whites using herbal medicine over blacks while two articles indicated that blacks used herbal medicine more frequently than whites.

Table 2 Non-Hispanic black use of herbal medicine.

 
Authors,
Data source
Black
White
Main results
Lead
publication year,
 
n, sex, age
N, sex, age
 
%1
citation
 


 
 
Bair et al.
Study of Women's health
941
1,557
18.6% of whites used herbal products as a form of CAM
W
2002 (19)
Across the Nation
women only
women only
14.9% of AAs used herbal products as a form of CAM
 
 
(SWAN)
(42-52 yrs)
(42-52 yrs)
 
 
Cuellar et al.
Convenience sample
40
143
23.2% of Caucasian Americans used herbs as a form of CAM
B
2003 (7)
survey
both
both
25.0% of AAs used herbs as a form of CAM
 
 
 
(50+ yrs)
(50+ yrs)
 
 
Mackenzie et al.
1995 National
1,048
1,114
12% of whites reported herbal medicine use as a form of CAM
B
2003 (20)
Comparative Survey of
both
both
19% of blacks/AAs reported herbal medicine use as a form of CAM
 
 
Minority Health Care of
(18+ yrs)
(18+ yrs)
 
 
 
the Commonwealth Fund
 
 
 
 
Cherniack & Pan
General survey
33
57
54% of whites reported using herbal products as a form of CAM
B*
2004 (21)
 
both
both
79% of AAs reported using herbal products as a form of CAM
 
 
 
(60+ yrs)
(60+ yrs)
 
 
Kuo et al.
Southern Primary-care
136
68
77.0% of whites reported wanting information on the effectiveness of herbal
W
2004 (22)
Urban Research
both
both
  products
 
 
Network (SPUR-Net)
(18+ yrs)
(18+ yrs)
64.0% of AAs reported wanting information on the effectiveness of herbal
 
 
 
 
 
  products
 
 
 
 
 
66.7% of whites reported using herbal products to their physician/
 
 
 
 
 
  pharmacist
 
 
 
 
 
44.7% of AAs reported using herbal products to their physician/pharmacist
 
 
 
 
 
14.7% of whites reported receiving information on herbal product
 
 
 
 
 
  effectiveness from their physician
 
 
 
 
 
8.8% of AAs reported receiving information on herbal product
 
 
 
 
 
  effectiveness from their physician
 
Conboy et al.
1997-1998 National
199
1,636
78.0% of whites used herbs as a form of CAM
W*
2005 (9)
Sample
both
both
5.5% of blacks used herbs as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Goldstein et al.
2001 California Health
961
3,660
55.5% of whites reported CAM use in general
W
2005 (10)
Interview Survey
both
both
5.8% of AAs reported CAM use in general
 
 
Complementary and
(18+ yrs)
(18+ yrs)
83.0% of whites reported using at least two dietary supplements (vitamin A,
 
 
Alternative Medicine
 
 
  vitamin B, vitamin C, vitamin D, vitamin E, lycopene, folic acid, calcium,
 
 
supplement (CHIS-CAM)
 
 
  selenium, zinc, glucosamine, Echinacea, fish oil, garlic pills, green tea,
 
 
 
 
 
  Ginkgo biloba, melatonin, valerian, soy products, black cohosh, DHEA,
 
 
 
 
 
  ma huang, saw palmetto, shark cartilage, dong quai, ginseng, St. John's
 
 
 
 
 
  wort, PC-SPES, and mistletoe) as a form of CAM in the past 12 months
 
 
 
 
 
81.8% of AAs reported using at least two dietary supplements as a form
 
 
 
 
 
  of CAM in the past 12 months
 
Graham et al.
2002 National Health
3,694
23,749
19.2% of non-Hispanic whites used herbal medicine as a form of CAM
W
2005 (23)
Interview Survey (NHIS)
both
both
14.1% of non-Hispanic blacks used herbal medicine as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Ness et al.
Sub-sample of the 2000
132
868
21% of non-Hispanic whites used herbal supplements as a form of CAM
W*
2004 (24)
wave of the Health and
both
both
10% of non-Hispanic blacks used herbal supplements as a form of CAM
 
 
Retirement Study
(52+ yrs)
(52+ yrs)
 
 
Hsiao et al.
2001 California Health
961
3,660
37.8% of whites used green tea as a form of CAM
B
2006 (11)
Interview Survey
both
both
39.5% of AAs used green tea as a form of CAM
 
 
Complementary and
(20+ yrs)
(20+ yrs)
9.7% of whites used garlic pills as a form of CAM
 
 
Alternative Medicine
 
 
16.3% of AAs used garlic pills as a form of CAM
 
 
supplement (CHIS-CAM)
 
 
15.6% of whites used ginseng as a form of CAM
 
 
 
 
 
23.5% of AAs used ginseng as a form of CAM
 
Kelley et al.
Slone Survey data
1,174
10,372
18% of whites reported herbal product use in the week before the survey
W
2006 (25)
 
both
both
  as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
11% of AAs reported herbal product use in the week before the survey
 
 
 
 
 
  as a form of CAM
 
Kronenberg
Cross-sectional
1,081
757
16.7% of non-Hispanic Whites used medicinal herbs and teas as a form
W
et al.
telephone survey
females only
females only
  of CAM 
 
2006 (12)
 
(18+ yrs)
(18+ yrs)
14.1% of AAs used medicinal herbs and teas as a form of CAM
 
Yoon
General survey
58
85
44.7% of whites reported herbal product use in the past 12 months
W*
2006 (26)
 
females only
females only
34.5% of AAs reported herbal product use in the past 12 months
 
 
 
(65+ yrs)
(65+ yrs)
 
 
Bardia et al.
2002 National Health
49
495
68.0% of whites reported herbal product use (including Echinacea)
draw
2007 (27)
Interview Survey (NHIS)
both
both
76.2% of blacks reported herbal product use (including Echinacea)
 
 
 
(18+ yrs)
(18+ yrs)
25.8% of whites reported herbal product use (excluding Echinacea)
 
 
 
 
 
16.3% of blacks reported herbal product use (excluding Echinacea)
 
 
 
 
 
Black adults were significantly less likely to consume herbs than their racial
 
 
 
 
 
  counterparts (with the exception of Echinacea)
 
Brown et al.
2002 National Health
4,256
none
67.6% of AAs reported using CAM in the past 12 months
na
2007 (13)
Interview Survey (NHIS)
both
 
CAM users were more likely female, college-educated, older, and insured
 
 
 
(18+ yrs)
 
14.2% of AAs used herbal products in the past 12 months as a form of CAM
 
Gardiner et al.
2002 National Health
14
64
29.7% of non-Hispanic whites reported herbal product or non-vitamin/mineral
B*
2007 (28)
Interview Survey (NHIS)
both
both
  supplement use (melatonin, bee pollen, fish oil, glucosamine, chondroitin,
 
 
 
(18-30 yrs)
(18-30 yrs)
  progesterone cream, or s-adenosylmethionine)
 
 
 
 
 
92.9% of non-Hispanic blacks reported herbal product or non-vitamin/
 
 
 
 
 
  mineral supplement use
 
Kennedy et al.
2002 National Health
2,901
19,375
37.4% of whites reported herbal product use to their physician
W
2007 (29)
Interview Survey (NHIS)
both
both
31.2% of blacks/AAs reported herbal product use to their physician
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Xu & Farrell
Medical Expenditure
7,196
27,584
34.4% of non-Hispanic whites used herbal products as a form of CAM
W*
2007 (14)
Panel Survey (MEPS)
both
both
18.8% of Blacks used herbal products as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Barner et al.
2002 National Health
2,952
none
50.4% of AAs used herbal medicine as a form of prevention-based CAM
NA
2010 (17)
Interview Survey (NHIS)
both
 
 
 
 
 
(18+ yrs)
 
 
 
Upchurch et al.
2002 National Health
879
3,933
26.2% of whites used herbal products as a form of CAM
W
2010 (18)
Interview Survey (NHIS)
females only
females only
19.5% of blacks used herbal products as a form of CAM
 
 
 
(40-59 yrs)
(40-59 yrs)
 
 
 
1 Lead % = a given form of CAM is used more by one ethnicity over the other.
*= a greater than 10% difference between whites and blacks for the primary chart dependent variable monitored. 
 
W= Whites use a given form of CAM more than blacks.  B= Blacks use a given form of CAM more than whites.
 
Draw= there is a mixture of dominance by whites and blacks for a table main dependent variable.
 
NA= article only discussed black use of CAM. 
 
 


 
Concerning the use of massage, Table 3 shows that 8 articles found that whites used massage more often than blacks, and no articles found that blacks used massage more often than whites.  Three of the articles demonstrated a greater than 10% difference in favor of whites.
 

Table 3 Non-Hispanic black use of massage.

 
Authors,
Data source
Black
White
Main results
Lead
publication year,
 
n, sex, age
N, sex, age
 
%1
citation
 


 
 
Bair et al.
Study of Women's health
941
1,557
20.2% of whites used physical methods (described as "massage,
W
2002 (19)
Across the Nation
women only
women only
  acupressure, or acupuncture") as a form of CAM
 
 
(SWAN)
(42-52 yrs)
(42-52 yrs)
11.7% of AAs used physical methods 
 
Cuellar et al.
Convenience sample
40
143
11.3% of Caucasian Americans used massage therapy as a form of CAM
W
2003 (7)
survey
both
both
10.0% of AAs used massage therapy as a form of CAM
 
 
 
(50+ yrs)
(50+ yrs)
 
 
Conboy et al.
1997-1998 National
199
1,636
76.0% of whites used massage as a form of CAM
W*
2005 (9)
Sample
both
both
6.6% of blacks used massage as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Goldstein et al.
2001 California Health
961
3,660
55.5% of whites reported CAM use in general
W
2005 (10)
Interview Survey
both
both
5.8% of AAs reported CAM use in general
 
 
Complementary and
(18+ yrs)
(18+ yrs)
18.2% of whites used a massage therapist as a form of CAM
 
 
Alternative Medicine
 
 
12.9% of AAs used a massage therapist as a form of CAM
 
 
supplement (CHIS-CAM)
 
 
 
 
Hsiao et al.
2001 California Health
961
3,660
29.4% of whites used a massage therapist as a form of CAM
W*
2006 (11)
Interview Survey
both
both
5.7% of AAs used a massage therapist as a form of CAM
 
 
Complementary and
(20+ yrs)
(20+ yrs)
 
 
 
Alternative Medicine
 
 
 
 
 
supplement (CHIS-CAM)
 
 
 
 
Kronenberg
Cross-sectional
1,081
757
13.1% of non-Hispanic whites used manual therapies (massage and
W
et al. 2006 (12)
telephone survey
females only
females only
  acupressure) as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
7.2% of AAs used manual therapies as a form of CAM
 
Brown et al.
2002 National Health
4,256
none
67.6% of AAs reported using CAM in the past 12 months
na
2007 (13)
Interview Survey (NHIS)
both
 
CAM users were more likely female, college-educated, older, and insured
 
 
 
(18+ yrs)
 
2.4% of AAs used massage in the past 12 months as a form of CAM
 
Xu & Farrell
Medical Expenditure
7,196
27,584
36.6% of non-Hispanic whites used massage as a form of CAM
W*
2007 (14)
Panel Survey (MEPS)
both
both
20.7% of blacks used massage as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Barner et al.
2002 National Health
2,952
none
46.8% of AAs used massage as a form of prevention-based CAM
NA
2010 (17)
Interview Survey (NHIS)
both
 
 
 
 
 
(18+ yrs)
 
 
 
Upchurch et al.
2002 National Health
879
3,933
8.5% of whites used massage as a form of CAM
W
2010 (18)
Interview Survey (NHIS)
females only
females only
3.1% of blacks used massage as a form of CAM
 
 
 
(40-59 yrs)
(40-59 yrs)
 
 
 
1 Lead % = a given form of CAM is used more by one ethnicity over the other.
*= a greater than 10% difference between whites and blacks for the primary chart dependent variable monitored. 
 
W= Whites use a given form of CAM more than blacks.  B= Blacks use a given form of CAM more than whites.
 
Draw= there is a mixture of dominance by whites and blacks for a table main dependent variable.
 
NA= article only discussed black use of CAM. 
 


Table 4 demonstrates that when observing the difference in chiropractic use, 13 articles showed that whites use chiropractic more often than blacks, with no articles showing that blacks used chiropractic care more often than whites.  Five articles demonstrated greater than 10% difference between the use pattern between whites and blacks.

Table 4 Non-Hispanic black use of chiropractic.

 
Authors,
Data source
Black
White
Main results
Lead
publication year,
 
n, sex, age
N, sex, age
 
%1
citation
 


 
 
Cuellar et al.
Convenience sample
40
143
19.0% of Caucasian Americans used chiropractic as a form of CAM
W*
2003 (7)
survey
both
both
7.5% of AAs used chiropractic as a form of CAM
 
 
 
(50+ yrs)
(50+ yrs)
 
 
Mackenzie et al.
1995 National
1,048
1,114
13% of whites reported chiropractic as a form of CAM
W
2003 (20)
Comparative Survey of
both
both
5% of blacks/AAs reported chiropractic as a form of CAM
 
 
Minority Health Care of
(18+ yrs)
(18+ yrs)
 
 
 
the Commonwealth Fund
 
 
 
 
Conboy et al.
1997-1998 National
199
1,636
85% of whites used chiropractic as a form of CAM
W*
2005 (9)
Sample
both
both
3.9% of blacks used chiropractic as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Goldstein et al.
2001 California Health
961
3,660
55.5% of whites reported CAM use in general
W
2005 (10)
Interview Survey
both
both
5.8% of AAs reported CAM use in general
 
 
Complementary and
(18+ yrs)
(18+ yrs)
16.3% of whites used chiropractic as a form of CAM
 
 
Alternative Medicine
 
 
10.0% of AAs used chiropractic as a form of CAM
 
 
supplement (CHIS-CAM)
 
 
 
 
Graham et al.
2002 National Health
3,694
23,749
8.8% of non-Hispanic whites used chiropractic as a form of CAM
W
 2005 (23)
Interview Survey (NHIS)
both
both
2.7% of non-Hispanic blacks used chiropractic as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Ness et al.
Sub-sample of the 2000
132
868
49% of non-Hispanic whites visited chiropractors as a form of CAM
W*
2005 (24)
wave of the Health and
both
both
25% of non-Hispanic blacks visited chiropractors as a form of CAM
 
 
Retirement Study
(52+ yrs)
(52+ yrs)
 
 
Hsiao et al.
2001 California Health
961
3,660
44.6% of whites reported using chiropractic as a form of CAM
W*
2006 (11)
Interview Survey
both
both
33.0% of AAs reported using chiropractic as a form of CAM
 
 
Complementary and
(20+ yrs)
(20+ yrs)
 
 
 
Alternative Medicine
 
 
 
 
 
supplement (CHIS-CAM)
 
 
 
 
Kronenberg et al.
Cross-sectional
1,081
757
16.2% of non-Hispanic whites used chiropractic as a form of CAM
W*
2006 (12)
telephone survey
females only
females only
5.9% of AAs used chiropractic as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Brown et al.
2002 National Health
4,256
none
67.6% of AAs reported using CAM in the past 12 months
NA
2007 (13)
Interview Survey (NHIS)
both
 
CAM users were more likely female, college-educated, older, and insured
 
 
 
(18+ yrs)
 
2.8% of AAs used chiropractic in the past 12 months as a form of CAM
 
Wolinsky et al.
Survey on Assets and
388
3,773
AAs demonstrated an Adjusted Odds Ratio (AOR) of 0.239 of seeing a
W
2007 (30)
Health Dynamics
both
both
  chiropractor, making them substantially less likely than whites to see
 
 
Among the Oldest Old
(70+ yrs)
(70+ yrs)
  them
 
 
(AHEAD)
 
 
 
 
Xu & Farrell
Medical Expenditure
7,196
27,584
14.5% of Non-Hispanic whites used chiropractic as a form of CAM
W
2007 (14)
Panel Survey (MEPS)
both
both
6.1% of blacks used chiropractic as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Ndetan et al.
2005 National Health
2,764
15,608
3.4% of white participants only saw a chiropractor as a form of healthcare
W
2009 (31)
Interview Survey (NHIS)
both
both
  as opposed to participants that only saw a MD.
 
 
 
(18+ yrs)
(18+ yrs)
1.3% of black participants only saw a chiropractor as a form of healthcare
 
 
 
 
 
  as opposed to participants that only saw a MD.
 
Barner et al.
2002 National Health
2,952
none
5.7% of AAs visited a chiropractor as a form of prevention-based CAM
NA
2010 (17)
Interview Survey (NHIS)
both
 
 
 
 
 
(18+ yrs)
 
 
 
Upchurch et al.
2002 National Health
879
3,933
11.2% of whites used chiropractic as a form of CAM
W
 2010 (18)
Interview Survey (NHIS)
females only
females only
3.1% of blacks used chiropractic as a form of CAM
 
 
 
(40-59 yrs)
(40-59 yrs)
 
 
Weigel et al.
Survey on Assets and
562
4,673
14.1% of whites report long-term chiropractic use over a 15-year period
W
2010 (32)
Health Dynamics Among
both
both
3.3% of AAs report long-term chiropractic use over a 15-year period
 
 
the Oldest Old (AHEAD)
(65+ yrs)
(65+ yrs)
 
 
 
+1993-2007 Medicare
 
 
 
 
 
claims
 
 
 
 
 
1 Lead % = a given form of CAM is used more by one ethnicity over the other.
*= a greater than 10% difference between whites and blacks for the primary chart dependent variable monitored. 
 
W= Whites use a given form of CAM more than blacks.  B= Blacks use a given form of CAM more than whites.
 
Draw= there is a mixture of dominance by whites and blacks for a table main dependent variable.
 
NA= article only discussed black use of CAM. 
 


 
Reviewing the use of acupuncture, Table 5 demonstrates that 9 articles illustrate that whites use acupuncture more often than blacks, with no articles showing the opposite.  Only one of the nine articles showed greater than 10% difference between white and black use of acupuncture.
 

Table 5 Non-Hispanic black use of acupuncture.

 
Authors,
Data source
Black
White
Main results
Lead
publication year,
 
n, sex, age
N, sex, age
 
%1
citation
 


 
 
Bair et al.
Study of Women's health
941
1,557
20.2% of whites used physical methods (described as "massage,
W
2002 (19)
Across the Nation
women only
women only
  acupressure, or acupuncture") as a form of CAM
 
 
(SWAN)
(42-52 yrs)
(42-52 yrs)
11.7% of AAs used physical methods as a form of CAM
 
Cuellar et al.
Convenience sample
40
143
0.7% of Caucasian Americans used acupuncture as a form of CAM
W
2003 (7)
survey
both
both
0.0% of AAs used acupuncture as a form of CAM
 
 
 
(50+ yrs)
(50+ yrs)
 
 
Mackenzie et al.
1995 National
1,048
1,114
1% of whites reported acupuncture as a form of CAM
draw
2003 (20)
Comparative Survey of
both
both
1% of blacks/AAs reported acupuncture as a form of CAM
 
 
Minority Health Care of
(18+ yrs)
(18+ yrs)
 
 
 
the Commonwealth Fund
 
 
 
 
Conboy et al.
1997-1998 National
199
1,636
86.0% of whites used acupuncture as a form of CAM
W*
2005 (9)
Sample
both
both
1.7% of blacks used acupuncture as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Goldstein et al.
2001 California Health
961
3,660
55.5% of whites reported CAM use in general
W
2005 (10)
Interview Survey
both
both
5.8% of AAs reported CAM use in general
 
 
Complementary and
(18+ yrs)
(18+ yrs)
3.1% of whites used acupuncture as a form of CAM
 
 
Alternative Medicine
 
 
2.4% of AAs used acupuncture as a form of CAM
 
 
supplement (CHIS-CAM)
 
 
 
 
Graham et al.
2002 National Health
3,694
23,749
1.0% of non-Hispanic whites used acupuncture as a form of CAM
W
2005 (23)
Interview Survey (NHIS)
both
both
0.7% of non-Hispanic blacks used acupuncture as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Hsiao et al.
2001 California Health
961
3,660
12.2% of whites reported using acupuncture as a form of CAM
W
2006 (11)
Interview Survey
both
both
9.0% of AAs reported using acupuncture as a form of CAM
 
 
Complementary and
(20+ yrs)
(20+ yrs)
 
 
 
Alternative Medicine
 
 
 
 
 
supplement (CHIS-CAM)
 
 
 
 
Kronenberg et al.
Cross-sectional
1,081
757
2.5% of non-Hispanic whites used acupuncture as a form of CAM
W
2006 (12)
telephone survey
females only
females only
0.9% of AAs used acupuncture as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Brown et al.
2002 National Health
4,256
none
67.6% of AAs reported using CAM in the past 12 months
NA
2007 (13)
Interview Survey (NHIS)
both
 
CAM users were more likely female, college-educated, older, and insured
 
 
 
(18+ yrs)
 
0.7% of AAs used acupuncture in the past 12 months as a form of CAM
 
Xu & Farrell
Medical Expenditure
7,196
27,584
9.4% of non-Hispanic whites used acupuncture as a form of CAM
W
2007 (14)
Panel Survey (MEPS)
both
both
6.9% of blacks used acupuncture as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
 
 
Barner et al.
2002 National Health
2,952
none
23.2% of AAs visited an acupuncturist as a form of prevention-based CAM
NA
2010 (17)
Interview Survey (NHIS)
both
 
 
 
 
 
(18+ yrs)
 
 
 
Upchurch et al.
2002 National Health
879
3,933
1.7% of whites used acupuncture as a form of CAM
W
2010 (18)
Interview Survey (NHIS)
females only
females only
0.4% of blacks used acupuncture as a form of CAM
 
 
 
(40-59 yrs)
(40-59 yrs)
 
 
 
1 Lead % = a given form of CAM is used more by one ethnicity over the other.
*= a greater than 10% difference between whites and blacks for the primary chart dependent variable monitored. 
 
W= Whites use a given form of CAM more than blacks.  B= Blacks use a given form of CAM more than whites.
 
Draw= there is a mixture of dominance by whites and blacks for a table main dependent variable.
 
NA= article only discussed black use of CAM. 
 


Table 6 summarizes the use of mind-body therapies. Five articles demonstrated that whites used this form of CAM more often than blacks, and none showed the opposite.  Two of the five articles demonstrated greater than 10% difference between blacks and whites.
 

Table 6 Non-Hispanic black use of mind-body therapies.

 
Authors,
Data source
Black
White
Main results
Lead
publication year,
 
n, sex, age
N, sex, age
 
%1
citation
 


 
 
Bair et al.
Study of Women's health
941
1,557
29.6% of whites used psychological interventions (such as
W*
2002 (19)
Across the Nation
females only
females only
  "meditation, mental imagery, or relaxation techniques") as a
 
 
(SWAN)
(42-52 yrs)
(42-52 yrs)
  form of CAM
 
 
 
 
 
11.6% of AAs used psychological interventions 
 
Cuellar et al.
Convenience sample
40
143
22.5% of Caucasian Americans used meditation as a form of CAM
draw
2003 (7)
survey
both
both
30.0% of AAs used meditation as a form of CAM
 
 
 
(50+ yrs)
(50+ yrs)
0.0% of Caucasian Americans used biofeedback as a form of CAM
 
 
 
 
 
5.0% of AAs used biofeedback as a form of CAM
 
 
 
 
 
2.8% of Caucasian Americans used yoga as a form of CAM
 
 
 
 
 
2.5% of AAs used yoga as a form of CAM
 
 
 
 
 
0.7% of Caucasian Americans used hypnosis as a form of CAM
 
 
 
 
 
0.0% of AAs used hypnosis as a form of CAM
 
 
 
 
 
1.4% of Caucasian Americans used T'ai chi as a form of CAM
 
 
 
 
 
0.0% of AAs used T'ai chi as a form of CAM
 
Conboy et al.
1997-1998 National
199
1,636
77.0% of whites used relaxation as a form of CAM
W*
2005 (9)
Sample
both
both
6.9% of blacks used relaxation as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
82.0% of whites used imagery as a form of CAM
 
 
 
 
 
2.3% of blacks used imagery as a form of CAM
 
 
 
 
 
86.0% of whites used biofeedback as a form of CAM
 
 
 
 
 
4.6% of blacks used biofeedback as a form of CAM
 
 
 
 
 
84.0% of whites used hypnosis as a form of CAM
 
 
 
 
 
1.8% of blacks used hypnosis as a form of CAM
 
 
 
 
 
78.0% of whites used yoga as a form of CAM
 
 
 
 
 
4.9% of blacks used yoga as a form of CAM
 
Goldstein et al.
2001 California Health
961
3,660
55.5% of whites reported CAM use in general
W
2005 (10)
Interview Survey
both
both
5.8% of AAs reported CAM use in general
 
 
Complementary and
(18+ yrs)
(18+ yrs)
24.9% of whites used mind-body techniques (guided imagery,
 
 
Alternative Medicine
 
 
  meditation, hypnosis, biofeedback) as a form of CAM
 
 
supplement (CHIS-CAM)
 
 
19.8% of AAs used mind-body techniques as a form of CAM
 
Graham et al.
2002 National Health
3,694
23,749
0.2% of non-Hispanic whites used biofeedback as a form of CAM
W
 2005 (23)
Interview Survey (NHIS)
both
both
0.1% of non-Hispanic blacks used biofeedback as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
0.3% of non-Hispanic whites used hypnosis as a form of CAM
 
 
 
 
 
0.2% of non-Hispanic blacks used hypnosis as a form of CAM
 
 
 
 
 
14.8% of non-Hispanic whites used relaxation techniques as CAM
 
 
 
 
 
13.6% of non-Hispanic blacks used relaxation techniques as CAM
 
 
 
 
 
1.2% of non-Hispanic whites used T'ai chi as a form of CAM
 
 
 
 
 
1.1% of non-Hispanic blacks used T'ai chi as a form of CAM
 
 
 
 
 
5.6% of non-Hispanic whites used yoga as a form of CAM
 
 
 
 
 
2.6% of non-Hispanic blacks used yoga as a form of CAM
 
Kronenberg
Cross-sectional
1,081
757
13.2% of non-Hispanic whites used mind-body practices (yoga,
W
et al. 2006 (12)
telephone survey
females only
females only
  meditation, T'ai chi, Chi gong) as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
5.0% of AAs used mind-body practices as a form of CAM
 
Brown et al.
2002 National Health
4,256
none
67.6% of AAs reported using CAM in the past 12 months
NA
2007 (13)
Interview Survey (NHIS)
both
 
CAM users were more likely female, college-educated, older, and insured
 
 
 
(18+ yrs)
 
3.2% of AAs used yoga or T'ai chi in the past 12 months as a form of CAM
 
 
 
 
 
0.2% of AAs used hypnosis in the past 12 months as a form of CAM
 
 
 
 
 
13.6% of AAs used relaxation in the past 12 months as a form of CAM
 
 
 
 
 
0.1% of AAs used biofeedback in the past 12 months as a form of CAM
 
Xu & Farrell
Medical Expenditure
7,196
27,584
1.9% of non-Hispanic whites used biofeedback as a form of CAM
draw
2007 (14)
Panel Survey (MEPS)
both
both
2.0% of blacks used biofeedback as a form of CAM
 
 
 
(18+ yrs)
(18+ yrs)
1.2% of non-Hispanic whites used hypnosis as a form of CAM
 
 
 
 
 
2.7% of blacks used hypnosis as a form of CAM
 
 
 
 
 
8.9% of non-Hispanic whites used meditation as a form of CAM
 
 
 
 
 
8.0% of blacks used meditation as a form of CAM
 
Barner et al.
2002 National Health
2,952
none
83.4% of AAs used yoga or T'ai chi as a form of prevention-based CAM
NA
2010 (17)
Interview Survey (NHIS)
both
 
18.1% of AAs used biofeedback as a form of prevention-based CAM
 
 
 
(18+ yrs)
 
76.3% of AAs used relaxation as a form of prevention-based CAM
 
Upchurch et al.
2002 National Health
879
3,933
11.5% of whites used meditation as a form of CAM
draw
2010 (18)
Interview Survey (NHIS)
females only
females only
9.2% of blacks used meditation as a form of CAM
 
 
 
(40-59 yrs)
(40-59 yrs)
6.1% of whites used yoga as a form of CAM
 
 
 
 
 
4.6% of blacks used yoga as a form of CAM
 
 
 
 
 
1.3% of whites used T'ai chi as a form of CAM
 
 
 
 
 
1.0% of blacks used T'ai chi as a form of CAM
 
 
 
 
 
0.2% of whites used biofeedback as a form of CAM
 
 
 
 
 
0.4% of blacks used biofeedback as a form of CAM
 
 
1 Lead % = a given form of CAM is used more by one ethnicity over the other.
*= a greater than 10% difference between whites and blacks for the primary chart dependent variable monitored. 
 
W= Whites use a given form of CAM more than blacks.  B= Blacks use a given form of CAM more than whites.
 
Draw= there is a mixture of dominance by whites and blacks for a table main dependent variable.
 
NA= article only discussed black use of CAM. 
 


There were 11 articles focusing on the use by blacks of CAM for specific health conditions.  Table 7 summarizes the chief details of five articles focused on diabetes, two on respiratory conditions, two on mental illness, one on chronic conditions, and one on AIDS.

Table 7 Non-Hispanic black use of CAM for specific disease states.

 
Authors,
Disease state
Data source
Black
White
Main results
Lead
publication year,
 
 
n, sex, age
N, sex, age
 
%1
citation
 
 
Black
White
 
 
 
 
 
 
 
 
 
Bell et al.
CAM use
2002 National Health
1,225
7,895
33.2% of non-Hispanic whites with diabetes report
W
2006 (33)
for diabetes
Interview Survey (NHIS)
both
both
  using CAM
 
 
 
 
(18+ yrs)
(18+ yrs)
28.8% of non-Hispanic blacks with diabetes report
 
 
 
 
 
 
  using CAM
 
 
 
 
 
 
39.5% of non-Hispanic whites without diabetes report
 
 
 
 
 
 
  using CAM
 
 
 
 
 
 
29.8% of non-Hispanic blacks without diabetes report
 
 
 
 
 
 
  using CAM
 
Garrow & Egede
CAM use
2002 National Health
379
1,708
48.4% of white diabetics report CAM use for diabetes
W*
2006 (34)
for diabetes
Interview Survey (NHIS)
both
both
34.6% of black diabetics report CAM use for diabetes
 
 
 
 
(18+ yrs)
(18+ yrs)
 
 
George et al.
CAM use
General survey
28
none
66% of AA asthmatics reported using prayer as a
NA
2006 (35)
for asthma
 
both
 
  form of CAM
 
 
 
 
(all)
 
36% of AA asthmatics reported using relaxation as a
 
 
 
 
 
 
  form of CAM
 
 
 
 
 
 
7% of AA asthmatics reported using biofeedback as
 
 
 
 
 
 
  a form of CAM
 
 
 
 
 
 
7% of AA asthmatics reported using yoga as a
 
 
 
 
 
 
  form of CAM
 
 
 
 
 
 
4% of AA asthmatics reported using meditation as a
 
 
 
 
 
 
  form of CAM
 
 
 
 
 
 
7% of AA asthmatics reported using chiropractic
 
 
 
 
 
 
  care as a form of CAM
 
Grzywacz et al.
CAM use
Evaluating Long-term
220
297
The AA unadjusted odds ratio of using food remedies
B
2006 (36)
for diabetes
Diabetes Self-management
both
both
  was 1.90 in relation to whites as a form of CAM
 
 
 
among Elder Rural adults
(65+ yrs)
(65+ yrs)
 
 
 
 
(ELDER) survey
 
 
 
 
Jones et al.
CAM use
Descriptive study focus
68
none
The most common alternative therapies used for
NA
2006 (37)
for diabetes
group
both
 
  diabetes are prayer, diet-based therapies, and
 
 
 
 
(21+ yrs)
 
  natural products
 
Schoenberg et al.
CAM use
General survey
20
20
5% of rural white diabetics report herbal CAM use
B
2006 (38)
for diabetes
 
both
both
  for diabetes
 
 
 
 
(50+ yrs)
(50+ yrs)
10% of AA diabetics report herbal CAM use
 
 
 
 
 
 
  for diabetes
 
 
 
 
 
 
0% of rural white diabetics report tea CAM use
 
 
 
 
 
 
  for diabetes
 
 
 
 
 
 
5% of AA diabetics report tea CAM use for diabetes
 
Bazargan et al.
CAM use
General survey
85
none
42% of depressed AAs report frequent use of CAM
NA
2008 (39)
for depression
 
both
 
 
 
 
 
 
(all)
 
 
 
Mehta et al.
CAM use
2002 National Health
2,901
19,375
35% of non-Hispanic whites reported herbal product
W
2008 (40)
for chronic
Interview Survey (NHIS)
both
both
  use to their physician
 
 
conditions
 
(18+ yrs)
(18+ yrs)
31% of non-Hispanic blacks reported herbal product
 
 
 
 
 
 
  use to their physician
 
Hipps et al.
CAM use for
General survey
41
none
AAs that consumed Breathe Easy® herbal tea 4
NA
2009 (41)
rhinosinusitus
 
both
 
  times a day changed their baseline SF-36 form
 
 
 
 
(35+ yrs)
 
  score up 9% after 6 weeks
 
Woodward et al.
CAM use for
National Survey of
631
1,393
39% of whites used CAM for mood, anxiety, or
W*
2009 (42)
mood, anxiety,
American Life (NSAL) and
both
both
  substance disorders
 
 
and substance
National Comorbidity
(18+ yrs)
(18+ yrs)
24% of AAs used CAM for mood, anxiety, or
 
 
abuse
Survey-Replication (NCS-R)
 
 
  substance disorders
 
Owen-Smith et al.
CAM use by
General survey
182
none
4.1% of AA AIDS patients reported using herbal
NA
2010 (43)
AAs with
 
both
 
  products as a form of CAM on a regular basis
 
 
AIDS
 
(all)
 
3.4% of AA AIDS patients reported using chiropractic
 
 
 
 
 
 
  as a form of CAM on a regular basis
 
 
 
 
 
 
2.0% of AA AIDS patients reported using massage
 
 
 
 
 
 
  as a form of CAM on a regular basis
 
 
 
 
 
 
25.2% of AA AIDS patients reported using meditation
 
 
 
 
 
 
  as a form of CAM on a regular basis
 
 
 
 
 
 
2.7% of AA AIDS patients reported using yoga
 
 
 
 
 
 
  a form of CAM on a regular basis
 
 
 
 
 
 
1.4% of AA AIDS patients reported using T'ai chi
 
 
 
 
 
 
  as a form of CAM on a regular basis
 
 
 
 
 
 
0.7% of AA AIDS patients reported using acupuncture
 
 
 
 
 
 
  as a form of CAM on a regular basis
 
 
 
 
 
 
52.4% of AA AIDS patients reported using prayer
 
 
 
 
 
 
  as a form of CAM on a regular basis
 
 
1Lead % = a given form of CAM is used more by one ethnicity over the other.
*= a greater than 10% difference between whites and blacks for the primary chart dependent variable monitored. 
 
W= Whites use a given form of CAM more than blacks.  B= Blacks use a given form of CAM more than whites.
 
Draw= there is a mixture of dominance by whites and blacks for a table main dependent variable.
 
 
NA= the journal only discussed black use of CAM. 
 


Discussion

CAM demographic studies show that most users of CAM are white, between the ages of 35 to 49, possess some level of college education, and have a household income over $50,000.9  Studies specifically focusing on blacks have found that CAM users are generally older, with an average age of 43.3; they are more likely to be female, have a college education, and possess insurance.13,44,45  Black participants who regularly use CAM report that it gives them a sense of power over their own health.45  A common reason for trying CAM among blacks is having another family member who has used it.44
 
Prayer has been found to be the most utilized form of CAM.46  Studies have shown distinct differences in the rates of morbidity and mortality between individuals who classify themselves as religious compared to those who do not.6  Religion appears to be very important to blacks. Church attendance, particularly among AA men, has been found to be a significant social support outlet to reduce stress.47  Decreasing stress level can have a beneficial impact on blood cortisol, a hormone that when released in excess can suppress immune function.48  Some studies on religiousness among AAs have had particularly startling results. For example, one article found that the average life expectancy for a 20-year old AA was 55.3 years for non-churchgoers and 62.9 years for churchgoers who attended church more than once per week.49  Changes like this reflect the powerful impact religion may have among blacks.
 
Various forms of herbal products have been found to be commonly used in treating health conditions. For example, echinacea has been marketed to treat the common cold.  Ginseng has been proposed to improve physical and cognitive performance.  Garlic has shown some capability of lowering blood cholesterol level.50  Overall whites have been found to use herbal products more than blacks.  The difference in pattern use, however, is debatable and thus likely is small.
 
Massage therapy is one of the most commonly used CAM therapies in North America. The health benefits of massage therapy have been an area that has not been extensively researched. Existing studies suggest massage therapy may have analgesic effects which reduce stress and result in positive patient outcomes in those suffering from acute musculoskeletal conditions.1,2,4  All articles in this review demonstrated that whites use massage as a form of CAM more often than blacks. The obstacles to massage use by blacks should be investigated.
 
All articles comparing chiropractic use by blacks to that of whites demonstrated that whites use chiropractic more often.  In many instances whites used chiropractic at least twice as often as blacks.7,9,12,14,18,20,23,31,32  Some have attributed this difference to the perception of discrepancies of healthcare treatment by blacks, lower average educational levels of blacks compared to whites, and the lack of accessibility to chiropractors in black communities.7,16,17,23  Additional study is warranted to determine why blacks use chiropractic care less often than whites.
 
Acupuncture has been used to treat a wide variety of conditions including: knee osteoarthritis, headaches, nausea during pregnancy, low back pain, chronic neck pain, and dysmenorrhea.51,52  Surveys have demonstrated that often patients seek out acupuncturists because conventional medical care has not helped them adequately.53 This review article illustrated the trend that whites use acupuncture more than blacks in all cases.  However, the difference between black and white use of acupuncture was often less than 3%.
 
Some techniques utilized as mind-body therapies are deep breathing, imagery, hypnotherapy, progressive relaxation, qi gong and T’ai chi. There is some evidence which suggests the importance of the “reciprocal body-mind relationship” in reducing patient subjective perception of pain and symptom severity.54,55 Mind-body therapies serve this role.  All articles from this review demonstrate the trend that whites use mind-body therapies more than blacks.  However, in many instances the difference in use is less than 5%.
 
Blacks have been shown to use CAM for various health conditions.  The most studied condition surveyed has been diabetes. Two articles stated blacks used CAM for diabetes more than whites and two stated the inverse, that white diabetics used CAM more often.  For asthma the chief form of CAM used by blacks was prayer. Similarly for black AIDS patients the chief form of CAM utilized by them was prayer.  Regarding herbal product use by blacks, they were found by Mehta et al. to be less likely than whites to report herbal product use to their medical doctor.

Study Limitations



Due to the limited number of black CAM-use articles, and overlapping data sets of many of them, the summary of this paper may not reflect the true reality of CAM usage of this population.  With some surveys there is the possibility of issues with the participant understanding the questions asked of them.  This may be due to differing cultural backgrounds of participants receiving the survey.  The extent to which this may have been an issue in many of the surveys referenced in this study has not been determined in research literature. 

Conclusions

Non-Hispanic blacks do not appear to utilize CAM as frequently as whites, with the exception of prayer.  Additionally, blacks do not use chiropractic services as often as whites.  If CAM use can in fact beneficially impact their health then the barriers that exist which prevent them from using CAM should be studied further.  By collecting additional survey data on these CAM use barriers countermeasures may be considered.
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